Provider Demographics
NPI:1902194566
Name:PHYSIATRY MANAGEMENT SERVICES OF TEXAS LLC
Entity Type:Organization
Organization Name:PHYSIATRY MANAGEMENT SERVICES OF TEXAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-680-1577
Mailing Address - Street 1:PO BOX 835808
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-5808
Mailing Address - Country:US
Mailing Address - Phone:972-680-1577
Mailing Address - Fax:972-690-9834
Practice Address - Street 1:7625 GLENVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8331
Practice Address - Country:US
Practice Address - Phone:972-680-1577
Practice Address - Fax:972-690-9834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-18
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty